Skip to main content

Data Collection (Forms) Library

Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions.

When you are searching for a form, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-13025 BadgerCare Plus Premium Employer Wage Withholding and Instructions DMS English 09/2013 PDF No
F-10139 BadgerCare Plus Premium Information / Payment DMS English 03/2018 PDF No
F-10139S BadgerCare Plus Premium Information / Payment (Spanish) DMS Spanish 03/2018 PDF No
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application DMS English 07/2008 PDF No
F-01726 Basic Equipment List for Nurse Aide Training Programs DQA English 01/2023 Word No
F-01346 Behavior Monitoring Record-Model (PDF, 521 KB) DPH English 09/2016 PDF No
F-62504 Behavioral Health Certification Section Initial Certification Application DQA English 11/2019 Word No
F-00922 Behavioral Health Integrated Care Health Home Certification Application DMS English 12/2013 PDF No
F-00922 Behavioral Health Integrated Care Health Home Certification Application DMS English 12/2013 Word No
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances DQA English 03/2013 PDF No
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances DQA English 03/2013 Word No
F-00276 Behavioral Health Services Recertification Application - DHS 94 Patients Rights and Resolution of Patient Grievances DHS 92 Confidentiality of Treatment Records DQA English 04/2011 PDF No
F-00276 Behavioral Health Services Recertification Application - DHS 94 Patients Rights and Resolution of Patient Grievances DHS 92 Confidentiality of Treatment Records DQA English 04/2011 Word No
F-02412 BioSense Platform Organization Security and Confidentiality Policy Agreement DPH English 11/2018 PDF No
F-02413 BioSense Platform User Security and Confidentiality Agreement DPH English 11/2018 PDF No
F-01427 Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting DMS English 02/2017 Word No
F-01427S Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting, Spanish DMS Spanish 02/2017 Word No
F-01428 Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP) DMS English 02/2017 Word No
F-01428S Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP), Spanish DMS Spanish 02/2017 Word No
F-22550 Birth to 3 Program Parental Cost Share DMS English 06/2017 PDF No
F-22550 Birth to 3 Program Parental Cost Share DMS English 06/2017 Word No
F-22550S Birth to 3 Program Parental Cost Share, Spanish DMS Spanish 06/2017 PDF No
F-22550S Birth to 3 Program Parental Cost Share, Spanish DMS Spanish 06/2017 Word No
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information DMS English 11/2019 Word No
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information DMS English 11/2019 PDF No
F-00632S Birth to 3 Program System of Payments and Consent to Access Private Insurance and Medicaid, Spanish DMS Spanish 11/2019 PDF No
F-00632S Birth to 3 Program System of Payments and Consent to Access Private Insurance and Medicaid, Spanish DMS Spanish 11/2019 Word No
F-12023 Birth to Three Program Exemption Request DMS English 08/2019 PDF No
F-12023H Birth to Three Program Exemption Request, Hmong DMS Hmong 08/2019 PDF No
F-12023S Birth to Three Program Exemption Request, Spanish DMS Spanish 08/2019 PDF No
F-01758 Blastomycosis Case Worksheet DPH English 08/2016 PDF No
F-01758 Blastomycosis Case Worksheet DPH English 08/2016 Word No
F-00017S Blood Lead Lab Report, Spanish DPH Spanish 01/2020 Word No
F-00017 Blood Lead Lab Reporting DPH English 01/2020 Word No
F-03292 Board for Evaluation of Interpreters (BEI) Certification Transfer Form DPH English 06/2024 Word No
F-40106 Breast Pump Loan and Release Agreement DPH English 08/2022 Word No
F-40106H Breast Pump Loan and Release Agreement, Hmong DPH Hmong 08/2022 Word No
F-40106S Breast Pump Loan and Release Agreement, Spanish DPH Spanish 08/2022 Word No
F-01153 Breast Pump Order DMS English 10/2024 PDF No
F-01153 Breast Pump Order DMS English 10/2024 Word No
F-01601F Budget - Opioid and Stimulant Unmet Needs DCTS English 10/2024 Excel No
F-01210B Budget Amendment Annual Verification (BAAV) Request DMS English 12/2015 Word No
F-00714 Business Associate Agreement - County or Tribal Contract DES English 05/2014 Word No
F-00811 Business Associate Agreement - No Contract DES English 06/2020 PDF No
F-00759 Business Associate Agreement: With Contract DES English 10/2022 PDF No
F-80462 Capital Asset Summary DES English 02/2012 Excel No
F-02331S Caregiver Programs Customer Satisfaction Survey DPH Spanish 05/2018 HTML No
F-02331 Caregiver Programs Customer Satisfaction Survey DPH English 05/2018 HTML No
F-00476 CARES Automated Systems Access Request DMS English 08/2023 PDF No
F-00476A CARES Automated Systems Access Request Instructions DMS English 08/2023 PDF No

Glossary

 
Last revised August 26, 2024